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APPLICATION FORMCCS Innovation Programme

£20 million First Call for Proposals

21 March 2012

Amended 31 May 2012 v1.2

Competition Application Form v1.2

Application Details

Notes on completion and submission of this form

Before completing this form, please refer to the document “Guidance for Applicants” for this Competition. The Guidance for Applicants and other competition documentation is available on the DECC website: http://www.decc.gov.uk/en/content/cms/emissions/ccs/innovation/inn_comp/inn_comp.aspx

Check what constitutes a complete submission for this stage of the competition. Details of any additional documentation required (which could include appendices and finance forms etc) are included in the Guidance for Applicants.

Completion of this form: Applicants must ensure that they complete this form within the boundaries of the templates and text areas as shown in PRINT VIEW or in the printed version of the application form. Any content entered which is not visible on the form or which goes beyond the page length indicated in the Guidance for Applicants will not be passed to the assessors of the application. The typeface, font size and colour for the text entry areas are must not be changed. The document must be saved as Microsoft Word document (.doc or .docx), prefixed with the word FINAL – only the last version marked FINAL will be assessed.

Please note that this application can be used for a single proposal ONLY. If you wish to make multiple proposals, please [register these separately and] complete separate Application Forms (with the accompanying paperwork as set out in the Guidance for Applicants) for each one.

Competition

DECC CCS Innovation Programme - £20 million Competition – First Call

Strand Please mark X as appropriate

Strand 1 - Feasibility studies

Strand 2 - Component development and demonstration

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http://www.decc.gov.uk/en/content/cms/emissions/ccs/innovation/inn_comp/inn_comp.aspx

DECC CCS £20 million Innovation Programme

Project Title

Project Timescales

Estimated start date

Duration (months)

Lead organisation name

Lead organisation contact details

Name

Address

Postcode

Email

Phone

Consortium Details (if applicable)

Please provide the registered names of all member organisations additional to the lead organisation listed above.

Registered names of member organisations

Member 1

Member 2

Member 3

Member 4

Member 5

Member 6

Appendices – please list here

4


Abstract of Proposed Project

Please provide a short summary of the content and objectives of your project including what is innovative about it. Please refer to the Guidance for Applicants.

Applicant Number (Internal DECC use only)

5


Section 1 – Cost reduction potential (Page 1 of 2)

Please refer to the Guidance for Applicants for the details of the specific questions to be addressed by applicants within each of these sections. Please number your answers.

6


Section 1 – Cost reduction potential (Page 2 of 2)

7


Section 2 – Likelihood of successful project (Page 1 of 2)


8


Section 2 – Likelihood of successful project (Page 2 of 2)

9


Section 3 – Funding and Added Value (Page 1 of 1)


10


Section 4 – Likelihood of subsequent commercial availability (Page 1 of 1)


11


Section 5 – Contribution to the expansion of the CCS industry(Page 1 of 2)


12


Public Description of the Project

If your application is successful, DECC will publish the following summary of your proposal to comply with Government requirements. Provision of this summary is mandatory but will not be assessed. Please ensure it is suitable for public disclosure.

Other Funding From Public Sector Bodies

If you have included one or more entries in column 7 of the Finance Summary Table, provide the name(s) of the bodies, the name of the programme or scheme from which the funds are provided, and the amount of the funds.

Public sector body name

Source of funds: Name of programme or scheme

Amount of funds (£)

Date on or by which funding

awarded(dd/mm/yyyy)

13


14


Finance Summary Table

To assist you with the Finance Section of this application form, please refer to the Guidance for Applicants. Please complete the information requested in the following table in accordance with the following notes. Ensure that the information requested is consistent with the applicable funding levels and eligible costs for your project, details of which are in the Guidance for Applicants. All Columns – please refer to the relevant section (page 33) in Part Three of the Guidance for Applicants document.

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Finance Summary Table

1 2 3 4 5 6 7 8

Organisation name Company Registration

Number

Enterprise Category

Postcode Contribution to project by each

organisation(£)

Funding sought from

DECC(£)

Other funding from public

sector bodies (£)

Total(£)

Lead Org. 0 0 0 0

Partner 1 0 0 0 0

Partner 2 0 0 0 0

Partner 3 0 0 0 0

Partner 4 0 0 0 0

Partner 5 0 0 0 0

Partner 6 0 0 0 0

Partner 7 0 0 0 0

Partner 8 0 0 0 0

Partner 9 0 0 0 0

Partner 10 0 0 0 0

Total (£) 1 0 0 0

Appendices

You must submit these with this Application Form. Please refer to Section 9 in the Guidance for Applicants document.

Signature of Lead Consortium Member

Please ensure a suitable representative from the lead consortium partner checks and signs this application before returning it to DECC.

Name of organisation

Signature

Name of Signatory (please print)

Position in organisation

Date


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